Healthcare Provider Details

I. General information

NPI: 1245282060
Provider Name (Legal Business Name): PETER OPPENHEIMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 N CONGRESS AVE
BOYNTON BEACH FL
33426-3415
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 561-336-0191
  • Fax: 561-364-7785
Mailing address:
  • Phone: 561-336-0191
  • Fax: 561-364-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME142493
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number147727
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: